@djh This is fascinating, I just learned that AAPS is an unlicensed hack to directly connect the glucose sensor to the pump and to control it in realtime. I would have expected that that is the default but apparently it's not.

So: Cool, but a bit dangerous.

@djh insulin pumps should never depend on a smart phone in any way.
Second point is that this type of data should not be exchanged with some sort of cloud driven by the manufacturer of pump or CGM.

@djh

Mobile phones are not intended to be medical devices.

It can be difficult to create a dedicated device. But to run life-critical software on an internet-connected computer where you have little control or knowledge of the inner workings?

Was the app actually killed by the phone to save power? Is there a bug that caused the app to be killed? Perhaps the bug is in the app, not the phone?

@djh thats bad product design, but Samsung is to blame as well, they're just bad at doing Android the right way imo.

@djh that's absolutely terrifying.

@djh wouldn't an insulin pump be a class one medical device under FDA regulations? Like.. erm.. wtf?

@djh “AAPS is an open source app for people living with insulin-dependent diabetes that acts as an artificial pancreas system (APS) on Google Android smartphones.”

https://androidaps.readthedocs.io/en/latest/

@djh @leafless …you’d think an insulin pump would have all the mission-critical stuff simply on-board, with all the smartphone integrations as an optional extra.

(The latter carefully firewalled off.)

@djh Android APS is an open source/patient-and-advocate-driven project. So…no approval involved, really. There’s a very long history here that I (pump wearing T1D) don’t know all the details of about unbelievably frustrating FDA/regulatory foot dragging on approving innovations in closed loop pump technology. The most specific early precipitating example was probably European regulators approving the first Medtronic Guardian system something like five+ years before the US did.

@djh oh god no do not make the insulin pump depend on an app

@djh 👀 what the (and I can’t stress this enough) the actual.

@djh

It never should have made it past a design review, let alone prototyping, testing, pre-production...

#fail #tech

@djh The Tandem t:slim x2 has the app built into the pump, which is why we chose it. Medical device software needs to run on medical device hardware. But I understand why some people would hack their systems to do this with unsanctioned hardware, because the benefits are amazing.

@djh somebody doing diy insulin pump control is kinda outside the approval process anyway ...

@djh #T1D myself. Of course, and of course this one is a system built from multiple parts with no certification. I actually considered setting up such a system for myself a few years back. It's the uncommon cases that made me back off.
I don't see it as a software problem, feedback loops are the easy bit. The hard parts are input signal - determining blood sugar levels over time and output - delivering insulin. I have difficulty with both. /...

@djh an app is bad enough, but depending on BT working 100% of the time is somehow even worse

@djh I'm not too familiar with the diabetes apps on android, but AAPS sounds like one of those DIY (or compile IY) diabetes apps that are not exactly approved by the local medical device approval authority.

But people use those anyway because the same QoL improving features they already have are to be released from the insulin pump manufacturer within the next couple of decades :D

@djh Much more this than a problem with the smart phone’s OS.

@crepererum @djh You might cry, but using Bluetooth for safety critical operation is pretty common these days. Well, and considering the poor quality of other safety critical components in such setups, the Bluetooth connection might often be the most reliable part of these systems. We have failed.

@crepererum @djh yes, but that is all that people are being offered or able to afford.

This is a systemic problem. Not a moral failing of someone who needs to take insulin.

@f4grx @djh That is also true. For automatic readout collection or something it makes sense to use a computer that can fail, but for something that *cannot be allowed* to fail, it really doesn't.

@sven_ola @djh OTOH the post mentions Samsung; I use a location tracker at a set interval on several phones and on a Samsung (A33) it gets completely killed every once in a while. It's as if the app never ran.